Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study

作者：Hui David^*; dos Santos Renata; Reddy Suresh; de Angelis Nascimento Maria Salete; Zhukovsky Donna S; Paiva Carlos Eduardo; Dalal Shalini; Costa Everaldo Donizeti; Walker Paul; Scapulatempo Heloisa Helena; Dev Rony; Crovador Camila Souza; De La Cruz Maxine; Bruera Eduardo

来源：Palliative Medicine, 2015, 29(9): 826-833.

DOI：10.1177/0269216315583031

• Complications
• hemorrhage
• infection
• intestinal obstruction
• morbidity
• neoplasms
• palliative care

Background: Limited information is available on the symptomatic complications that occur in the last days of life.
Aim: We documented the frequency, clinical course, and survival for 25 symptomatic complications among patients admitted to acute palliative care units.
Design: Prospective longitudinal observational study.
Measurements: Their attending physician completed a daily structured assessment of symptomatic complications from admission to discharge or death.
Setting/participants: We enrolled consecutive advanced cancer patients admitted to acute palliative care units at MD Anderson Cancer Center, USA, and Barretos Cancer Hospital, Brazil.
Results: A total of 352 patients were enrolled (MD Anderson Cancer Center=151, Barretos Cancer Hospital=201). Delirium, pneumonia, and bowel obstruction were the most common complications, occurring in 43%, 20%, and 16% of patients on admission, and 70%, 46%, and 35% during the entire acute palliative care unit stay, respectively. Symptomatic improvement for delirium (36/246, 15%), pneumonia (52/161, 32%), and bowel obstruction (41/124, 33%) was low. Survival analysis revealed that delirium (p<0.001), pneumonia (p=0.003), peritonitis (p=0.03), metabolic acidosis (p<0.001), and upper gastrointestinal bleed (p=0.03) were associated with worse survival. Greater number of symptomatic complications on admission was also associated with poorer survival (p<0.001).
Conclusion: Symptomatic complications were common in cancer patients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.

• 出版日期2015-10